Steps to get on PrEP

NOTE: there is a finan­cial cost for using PrEP in the Nether­lands. Depend­ing on where you do your tests, expect around 30 euro’s per month min­i­mum if you take PrEP on a dai­ly basis

Step 1: Choose your doctor

If you want to take PrEP, you need a doctor to monitor your test results and give you a prescription. In the Netherlands, there are 3 options:

Fam­i­ly doc­tor
While most doc­tors see the ben­e­fit of PrEP, we know from expe­ri­ence that some (fam­i­ly) doc­tors are not too excit­ed to pre­scribe PrEP. There can be sev­er­al rea­sons for this. For one thing, you could be the first per­son in your doctor’s prac­tice who asks for PrEP. If so, your doc­tor will need to do some home­work. But there are also cas­es where doc­tors sim­ply do not want to give you a pre­scrip­tion. The most often heard argu­ment is a fear for an increase in STIs. Which is strange, of course, as you don’t ask for PrEP with­out good rea­son. You may want to print out these pro­fes­sion­al PrEP guide­lines (in Dutch) and bring them to your doc­tor. These guide­lines describe in detail how your doc­tor can assist you with using PrEP.

Rule of thumb: if it requires a lot of effort to con­vince your (fam­i­ly) doc­tor to give you a pre­scrip­tion for PrEP, look for a dif­fer­ent doc­tor.

GGDSTI clin­ic
Ask the STI clin­ic (“soapoli”) at the GGD (pub­lic health ser­vice) if they can help you get on PrEP. Some of the GGDSTI clin­ics are able to assist you. Here is a list of avail­able GGDSTI clin­ics.

HIV-treat­ment cen­tre
Con­tact your near­est HIV-treat­ment cen­tre. The HIV-spe­cial­ists can pre­scribe PrEP for you. Since the HIV-spe­cial­ist is expen­sive this will cost you your deductible excess (‘eigen risi­co’). You also need a refer­ral from your fam­i­ly doc­tor. Ask the HIV-spe­cial­ist for help if your fam­i­ly doc­tor is not coop­er­at­ing.

Step 2: Get tested

Before starting PrEP, you need to get tested for a number of things. These tests need to be repeated on a regular basis.

HIV (before start­ing PrEP, a month after start­ing PrEP, and every 3 months from then on)

Kid­ney func­tion (before start­ing PrEP, a month after start­ing PrEP, and every 3 to 6 months from then on)

Chlamy­dia, gon­or­rhea, syphilis, and hepati­tis C (every 3 months)

Hepati­tis B (only before start­ing PrEP)

Costs

To save cost, you can get test­ed for HIV, chlamy­dia, gon­or­rhea, syphilis and hepati­tis B for free at your local GGDSTI clin­ic, or you can arrange a test online via Man­tot­Man Test­lab.

Test­ing your kid­ney func­tion and hepati­tis C is usu­al­ly only be pos­si­ble via your fam­i­ly doc­tor, and these two tests togeth­er will incur a charge of about €15,- on your deductible excess (‘eigen risi­co’) every time you get test­ed.

Of course, it is pos­si­ble to get all tests done at your fam­i­ly doctor’s office, but the cost for STD test­ing is charged on your deductible. All tests togeth­er will cost about €210,- every time. If you have already met your deductible, it does not mat­ter where you get test­ed, since STD tests are then cov­ered under Dutch health insur­ance (‘basisverzek­er­ing’).

IMPORTANT: If you use PrEP, you need to get test­ed for HIV, kid­ney func­tion, chlamy­dia, gon­or­rhea, syphilis, and hepati­tis C EVERY 3 MONTHS. Put it in your cal­en­dar, write it on your bath­room mir­ror, stick a note on your fridge.

Your doc­tor will not give you a new pre­scrip­tion if you did not get test­ed, so it is impor­tant that you real­ly keep up with the tests and that you make a new appoint­ment with your doc­tor in time.

Step 3: Get your prescription

Once you’ve gotten all the tests done, and your doctor does not find any obstructions for prescribing PrEP, it is time for your prescription.

Ask your doc­tor to pre­scribe gener­ic Emtric­itabine-Teno­fovir diso­prox­il. These are the two med­ica­tions that togeth­er make PrEP. There should not be a brand name on the pre­scrip­tion.

IMPORTANT: do you use oth­er med­ica­tions besides PrEP? Be sure to tell your doc­tor. Cer­tain med­ica­tions do not go well togeth­er with PrEP. Your phar­ma­cy can also check this for you.

Tip: once you get your pre­scrip­tion, make your next doctor’s appoint­ment right away!

Step 4: Buy your PrEP

You can buy PrEP at the pharmacy. You will need to bring your prescription to the pharmacy.

Unfor­tu­nate­ly, PrEP is not cov­ered by Dutch health insur­ance, so you will have to pay for it your­self. PrEP costs at least €27,50 per 30 pills.

Despite the dif­fer­ent brand names, all of the options work equal­ly well. The only excep­tion is Cen­tra­farm, which pos­si­bly has a lim­it­ed expi­ra­tion date. This is only a prob­lem if you do not use PrEP every day. In that case, ask for one of the oth­er brands.